The U.S. Supreme Court is probing the constitutionality of how federal health officials are appointed, in a case that could upend the Affordable Care Act’s preventive care mandates.
At a Glance
- Supreme Court reviews preventive services mandate under ACA
- Justices scrutinize USPSTF appointments and HHS authority
- Reorganization Plan of 1966 key to legal dispute
- Ruling could end cost-free coverage for statins, PrEP
- Decision expected by June 2025
Supreme Court Case Overview
On April 21, 2025, the Supreme Court heard oral arguments in Kennedy v. Braidwood Management, a constitutional challenge to the Affordable Care Act’s requirement that insurers cover preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) without cost-sharing. The plaintiffs contend that the USPSTF is unconstitutionally structured because its members were not appointed under the U.S. Constitution’s Appointments Clause, which requires presidential nomination and Senate confirmation for “officers of the United States,” as explained in a detailed KFF legal analysis.
The Fifth Circuit Court of Appeals ruled in favor of the plaintiffs but limited the ruling’s scope to the case’s specific parties. The Supreme Court’s decision could dramatically expand or constrain that reach, potentially reshaping how federal health guidelines are created and enforced.
Watch Reason’s breakdown of the Court’s inquiry at The Supreme Court’s Order for Supplemental Briefing in Kennedy v. Braidwood.
The Reorganization Plan and Appointment Authority
In a rare procedural turn, the Court has ordered supplemental briefs on whether Congress legally authorized the Secretary of Health and Human Services to appoint members of the USPSTF. The government argues that this power stems from the Reorganization Plan of 1966, which was ratified into law in 1984 alongside all earlier reorganization plans.
Justice Clarence Thomas raised concerns over the absence of clear statutory support, asking directly, “What’s the statutory authority to appoint the Task Force?” Government counsel Hashim Mooppan responded that the authority flows from the Reorganization Act and the relevant federal code—allowing the Secretary to act on the former director’s powers to convene the Task Force.
At issue is whether USPSTF members function more like federal officers—who require Senate-confirmed appointments—or like advisors, who do not. Past rulings such as United States v. Hartwell and United States v. Smith have emphasized statutory clarity in federal appointments.
Broader Ramifications for U.S. Healthcare
A ruling that invalidates the USPSTF’s authority would remove federal enforcement for cost-free coverage of dozens of services added since 2010. These include statins, lung cancer screenings, and PrEP, a preventive HIV medication considered crucial in public health efforts.
Critics of the lawsuit warn that the decision could disproportionately affect low-income and marginalized populations who rely on ACA-compliant plans for preventive healthcare. Health law experts note that the ruling could limit the executive branch’s ability to delegate decision-making across federal agencies, with implications extending well beyond healthcare.
The Court’s final decision, expected by June, may either uphold the ACA’s preventive service guarantees or rewrite key expectations around federal appointments, reshaping the structure of administrative governance in the United States.
